Oral health habits, chewing function, and dietary behaviors established in childhood influence health across the life course. In Japan, delays in oral functional development and the category of pediatric oral hypofunction have become a public health concern, with oral hypofunction added to the national dental health insurance list in 2018. Insufficient oral function can impair eating and contribute to imbalanced nutrition. Given documented links between parental behaviors and children’s oral and dietary patterns, interventions that combine education for both children and caregivers may support healthier lifelong habits.
The Comprehensive Awareness Modification of Mouth, Chewing, and Meal (CAMCAM) program was previously developed for older adults to promote oral, nutritional, and physical behaviors by pairing brief education with a textured meal designed to increase chewing. This pilot study adapted CAMCAM for children and their caregivers (CAMCAM-P for kids) to test feasibility and preliminary changes in awareness and behaviors when implemented in community children’s cafeterias.
This was a single-group pre–post pilot intervention without a control group conducted between April 2023 and December 2024. Participants were recruited by convenience sampling from two community children’s cafeterias in Tokyo that had established collaboration with the research team. A total of 84 participants enrolled: 52 children and 32 parents/guardians who were regular cafeteria attendees and had no food allergies that would interfere with the program. Written informed consent from guardians and assent from children were obtained. The study received ethical approval from the Ethics Committee of the Faculty of Dentistry, Institute of Science Tokyo (D2022-026) and was registered with UMIN (UMIN000048328).
CAMCAM-P for kids ran once monthly for six months. Each session included a roughly 10-minute lecture delivered by dentists, dental hygienists, and registered dietitians that covered oral health, chewing mechanics, and basic nutrition. The educational component was paired with a specially designed CAMCAM bento served at each session. The bento used strategies intended to promote chewing: selecting higher-chewiness foods, cutting ingredients into larger pieces, shortening cooking times, and reducing moisture content.
To support ongoing engagement, a mobile application sent weekly short informational messages (approximately 200 characters) on oral health, nutrition, and chewing, and provided access to recorded lectures.
The study team developed a child-specific CAMCAM Checklist to assess awareness and behaviors relevant to oral health, diet, and chewing. The questionnaire covered: toothbrushing behaviors (including autonomous brushing for children and parental-assisted brushing for caregivers), frequency of oral-cavity self-observation, dental visits, fluoride use, meal patterns (number of meals, breakfast frequency, eating breakfast together), consideration of nutritional balance, and chewing-related attention (e.g., consideration of chewing cycles). Food intake diversity was measured using a Dietary Variety Score, and intake frequency for specific food groups was recorded. The complete questionnaire is provided in the study’s supplementary materials.
Analyses compared pre-intervention and post-intervention responses for children and caregivers. As this was a pilot feasibility study without a control group, analyses focused on within-participant changes in awareness, behaviors, and reported food intake frequencies. The manuscript reports p-values for selected comparisons. All procedures complied with the Declaration of Helsinki and national ethical guidelines.
Median ages reported in the study were 8.5 years (range 6–16) for children and 43.0 years (range 36–50) for parents/guardians. Participants were regular users of the participating cafeterias. Details on session attendance rates and attrition were provided in the full manuscript and supporting information.
After six monthly sessions, several favorable changes were reported. The frequency of self-observation of the oral cavity among children increased. Daily fluoride use among children rose from 61.5% pre-intervention to 76.9% post-intervention (p = 0.020). The proportion of children who reported not considering nutritional balance decreased from 63.5% to 38.5% (p = 0.022), indicating improved attention to diet composition. Among parents/guardians, the proportion who actively practiced a nutritionally balanced diet increased from 56.2% to 75.0%, though this change did not reach statistical significance as reported.
Participants also reported greater attention to chewing behaviors: the number of individuals who did not consider the number of chewing cycles decreased after participation.
Post-intervention changes in reported food intake frequency were observed. Caregivers reported increased intake frequencies for meat, dairy products, and tubers. Children reported increased frequencies for rice, tubers, and fruits. Dietary Variety Score items and specific intake-frequency results are presented in the manuscript tables and supplementary files.
The intervention was implemented in existing community children’s cafeterias, leveraging their stable user populations and existing trust relationships. Educational sessions were brief (10 minutes) and integrated with a meal that physically reinforced the educational goal (increasing chewing). Use of a mobile application for weekly messaging and recorded lectures provided ongoing touchpoints between monthly in-person sessions. The pilot design emphasized feasibility and preliminary outcome signals rather than definitive efficacy.
As a single-group pre–post pilot without a control group, the authors emphasize that results are preliminary and cannot establish causality. The convenience sample from two cafeterias limits generalizability. The study relied on self-reported questionnaire data for behavioral and dietary outcomes. The authors recommend larger controlled studies to confirm effectiveness and to further evaluate implementation fidelity, longer-term behavior change, and objective oral-function or nutritional endpoints.
In summary, participation in CAMCAM-P for kids was associated with improvements in oral health awareness (including increased fluoride use) and greater attention to nutritional balance and chewing among children and their caregivers in this pilot feasibility study conducted in community children’s cafeterias in Tokyo.